肺大细胞神经内分泌癌的MSCT表现

目的探讨肺大细胞神经内分泌癌(LCNEC)的MSCT表现。方法回顾性分析27例经手术病理证实为LCNEC患者的MSCT影像与病理资料。所有患者术前均接受胸部CT平扫,其中20例接受增强扫描。结果 23例表现为肺内单发肿块,4例表现同侧肺内为多发结节;26例为周围型,仅1例为中央型;肿块或结节最大径为1.2～14.2cm[平均(5.2±2.1)cm]。主要CT征象:肿块或结节边缘光滑20例(20/27,74.07%),肿块内片状坏死9例(9/27,33.33%)、点状钙化2例(2/27,7.41%);分叶征19例(19/27,70.37%),毛刺征13例(13/27,48.15%),空泡征3例(3/27,11.11%),胸膜牵拉征7例(7/27,25.93%),伴肺内阻塞性病变4例(4/27,14.81%)。增强后20例病灶均呈不均匀强化。14例(14/27,51.85%)可见同侧肺门或纵隔、隆突下淋巴结肿大,其中8例病理证实为淋巴结转移。1例(1/27,3.70%)肿块累及胸壁,1例(1/27,3.70%)发生骨转移,1例(1/27,3.70%)发生脑转移,1例(1/27,3.70%)发生全身转移。结论 LCNEC影像学表现复杂,缺乏特征性,诊断需结合病理学。

MSCT findings of lung large cell neuroendocrine carcinoma

Objective To observe MSCT findings of lung large cell neuroendocrine carcinoma (LCNEC). Methods MSCT and pathologic findings of 27 patients with LCNEC were reviewed. All patients received plain CT , while 20 of them received enhanced CT scan. Results LCNEC presented as single lung mass in 23 patients, while as multiple nodules of unilateral lung in 4 patients, which located peripherally in 26, but centrally only 1 patient, with diameters ranged from 1.2 to 14.2 cm (average cm).The tumors were smooth and well defined in 20 cases (20/27, 74.07%), while necrosis was found in 9 cases (9/27, 33.33%)and calcification was detected in 2 cases (2/27, 7.41%). Lobulation of tumors was noticed in 19 cases (19/27, 70.37%), spiculation was observed in 13 cases (13/27, 48.15%), while vacuoles, pleural traction , obstructive atelectasis or pneumonia were found in 3(3/27, 11.11%), 7(7/27, 25.93%)and 4 cases(4/27,14.81%), respectively. After injection of contrast agent, irregular enhancement of tumors was observed in all 20 cases that underwent enhanced CT scan. Mediastinal or hilar lymphadenectasis were observed in 14 cases (14/27, 51.85%), among which 8 cases were proved as metastasis. Adjacent chest wall invasion, bone metastasis or brain metastasis was detected in 1 case (1/27, 3.70%), respectively. While whole body metastasis was found in 1 case (1/27, 3.70%). Conclusion The imaging features of LCNEC were very complicated and lack of characteristic. The final diagnosis depends on combining imaging and pathology.